Balancing Urgency and Strategy in the Surgical Management of a Complex Case of Gallstone Ileus: A Surgical-Video-Based Case Report of a 60-Year-Old Female.

Autor:	Alabdullah H; Department of Surgery, King Saud University Medical City, Riyadh, SAU., Aldarsouni FG; Department of Trauma Surgery, King Saud Medical City, Riyadh, SAU.; Department of General Surgery, Prince Sultan Military Medical City, Riyadh, SAU., Dagestani H; Department of Surgery, King Saud University Medical City, Riyadh, SAU.; Department of Surgery, Al-Iman General Hospital, Riyadh, SAU., Mashbari H; Department of Surgery, Jazan University, Jazan, SAU.; Department of Surgery, King Saud University Medical City, Riyadh, SAU.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Aug 20; Vol. 16 (8), pp. e67304. Date of Electronic Publication: 2024 Aug 20 (Print Publication: 2024).
DOI:	10.7759/cureus.67304
Abstrakt:	Gallstone ileus is an uncommon but potentially life-threatening complication of gallstone disease, characterized by the obstruction of the gastrointestinal tract by a gallstone, typically at the ileocecal valve. This condition predominantly affects elderly patients and carries a high risk of morbidity and mortality due to delayed diagnosis and the complexity of associated comorbidities. We report the case of a 60-year-old woman with a history of hypertension and cholelithiasis who presented with a four-day history of intermittent epigastric pain, nausea, vomiting, and an inability to pass stool or flatus. Initial imaging studies, including ultrasonography and computed tomography, revealed a biliary-enteric fistula with a large obstructing gallstone at the ileocecal valve. Despite conservative management with intravenous fluids, nasogastric tube suction, and antibiotics, the patient's symptoms persisted, necessitating surgical intervention. A midline laparotomy was performed, during which the gallstone was successfully removed via enterotomy. The patient recovered without complications and was discharged in stable condition. The complexity of management, particularly in elderly patients with multiple comorbidities, necessitates careful consideration between the one-stage and two-stage surgical approaches. In this case, the decision to perform an enterotomy without immediate cholecystectomy reflects a two-stage strategy, aimed at minimizing operative risk while addressing the immediate obstruction. This approach underscores the need for individualized management plans, where the choice between one-stage and two-stage surgery is guided by the patient's overall clinical status. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Alabdullah et al.)
Databáze:	MEDLINE
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